Date 1

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 2

NILKHANT ENTERPRISE

SINGH SHOPPING CENTER, W E HIGHWAY ROAD,


DAHISAR EAST, NR MANSAROWAR HOTEL, MUMBAI - 400068

`Date : 28/04/2018

Declaration regarding Food Safety Management System (FSMS)

I Mr. JAYANTI N AGHERA proprietor of M/s. NILKHANT ENTERPRISE located at


SINGH SHOPPING CENTER, W E HIGHWAY ROAD, DAHISAR EAST, NR
MANSAROWAR HOTEL, MUMBAI – 400068 of the state MAHARASHTRA hereby
declare that:

1. I am an applicant for NEW LICENSE under the Food Safety and Standards Act
(FSS Act) 2006.
2. The Nature of Business of my/our firm is Retail Shop for regular customer.
3. I/We have a food safety plan to ensure that the articles of food, as mentioned
above, satisfy the requirement of the FSS Act, 2006 and the rules and
regulations there under.
4. I/We further undertake that I/we shall put in place a food safety Management
system and get the same certificated from an Accredited Agency as soon as the
accredited agencies are notified by the Food Authority.
5. Our facility shall comply with general hygiene and sanitary requirements as
mentioned in the schedule 4 of the food safety and Standards (Licensing and
Registration of Food Business) regulations 2011.

NIKHANT ENTERPRISE
SINGH SHOPPING CENTER,
W E HIGHWAY ROAD, DAHISAR EAST, Signature of Authorized with Stamp/Seal
NR MANSAROWAR HOTEL MUMBAI 68
Name : JAYANTI N AGHERA
Place : MUMBAI Address : SINGH SHOPPING CENTER,
W E HIGHWAY ROAD, DAHISAR EAST,
NR MANSAROWAR HOTEL, MUMBAI –
400068
Date : 26TH APRIL 2018 Contact No : 9137002007
NILKHANT ENTERPRISE
SINGH SHOPPING CENTER, W E HIGHWAY ROAD,
DAHISAR EAST, NR MANSAROWAR HOTEL, MUMBAI - 400068
FORM NO.IX

(Form of Nomination – Refer rule 2.5.1)

NOMINATION OF PERSONS BY A COMPANY

Being the proprietor or a signatory authorized by the board of directors of the company in terms of Rule
2.5.1 (2), I do hereby gives notice that the following persons(s) is/are nominated as the person(s) in
charge of establishment, branch or the unit mentioned against the name of the person(s) and shall be
responsible and liable for food safety or any contravention of the Act and rules/regulations or directions
issued thereunder in respect of the concerned establishment/branch/unit. The person(s) shall take all
such steps as may be necessary to prevent the commission by the Company of any offence under and
comply with the provisions of Food Safety and Standards Act, 2006 and the Rules and Regulations made
thereunder.

Branch wise/office wise nomination .

Establishment/branch/unit name Name and Sign of Person i/c

1. NIKHANT ENTERPRISE 1. JAYANTI N AGHERA

2. 2.

3. 3.

A certified copy of the resolution of the board regarding the authorized

signatory, dated 28TH APRIL 2018 is enclosed.

Place : MUMBAI For NIKHANT ENTERPRISE

Date: 28/04/2018

1. Authorized signatory of the company

Place:

Date:

You might also like